Heart test could save babies' lives

A routine screening test for all newborn babies could save the lives of some born with congenital heart defects, say researchers.

A routine screening test for all newborn babies could save the lives of some born with congenital heart defects, say researchers . A number of babies' heart defects are spotted during a mid-pregnancy ultrasound scan and others may be picked up in the routine physical examination after delivery.

But sometimes the problem is not spotted until the baby becomes ill at home. Congenital heart defects are one of the main causes of of baby deaths in the developed world. A study published in the Lancet says lives could be saved if all newborn babies were given a cheap and simple test to establish the oxygen levels in their blood.

Small studies of the pulse oximetry test – in which sensors are placed on a hand and foot – have proved inconclusive, so the National Institute for Health Research funded the study by Andrew Ewer and colleagues from Birmingham University and Birmingham Women's hospital to determine whether it would be useful for the NHS. Their study in six maternity centres in the UK involved 20,000 babies between February 2008 and January 2009.

The test detected 75% of all critical cases (those that result in death or surgery within 28 days of birth) and 49% of major congenital heart defects (causing death without surgery within 12 months).

Some of these heart defects had already been spotted during the antenatal ultrasound scan, however. Excluding those, pulse oximetry identified 58% of unsuspected critical cases and 28% of major ones. It wrongly identified some babies as having congenital heart defects, but some of those were found to be suffering from other diseases.

The authors calculate that 264 out of 100,000 newborn babies would have major congenital heart defects‚ 130 of which would be identified by the test.

Around 120 babies would be critical cases, 90 of whom would be identified by pulse oximetry. Combining the test with ultrasound and the routine physical examination after birth, 92% of congenital heart defects were identified. No babies in the study died from undiagnosed heart disease. "Pulse oximetry is a safe, non-invasive, feasible and reasonably accurate test which has sensitivity which is better than that of antenatal screening and clinical examination. It adds value to existing screening and is likely to be useful for identification of cases of critical congenital heart defects that would otherwise go undetected," say the authors. The Department of Health said the UK national screening committee would consider the study.

"The NHS has a long and proud track record of innovation that has driven major improvements in patient care in the past, and we welcome the findings of this study. Currently all newborn babies undergo a routine screening, including careful assessment of cardiovascular system. This study shows the potential benefit of pulse oximetry screening as part of that."

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